Reviewed by Dr. Roger C. Mixter

Blepharoplasty (also known as cosmetic eyelid surgery, eyelid lift and eyelid tuck) is a cosmetic procedure done to correct sagging or drooping upper eyelids. A blepharoplasty can also be used to remove excess or herniated fat, skin or atrophied muscle around the eyes. Most blepharoplasties are done to improve appearance and create a more youthful look. In rare cases, blepharoplasty may be needed to correct eyelids that droop down far enough to interfere with vision.

“Blepharoplasty” can refer to plastic surgery on either the upper or lower lids.. One type of plastic surgery on the lower lid is called canthopexy and is discussed here. While canthopexy can improve the look of a lower lid, blepharoplasty usually refers to the removal of fat or other tissue on the lower lid .

As people age, they often begin to notice saggy skin and bags around the eye, which can make the upper eyelid seem to disappear. Blepharoplasty can often correct these problems and help return a youthful appearance your face. The difference between before-and-after blepharoplasty photos can be quite dramatic, and people generally appear much younger and more refreshed after surgery.

There are many different types of eyelid surgeries, and your surgeon should be one who is knowledgeable about and has a lot of experience with the procedure you need. For example, a patient of Asian descent who will be undergoing eyelid surgery should select a surgeon familiar with Asian faces and their structure. Cosmetic eyelid surgery can also create a crease in the upper eyelid for Asian eyes that do not have one. Click here to learn more about Asian eyelid surgery.

The benefits of a blepharoplasty include a more youthful and more alert appearance, and possibly improved vision resulting from the removal or readjustment of droopy eyelids. Blepharoplasty will not eliminate wrinkles around the eye area or lift your eyebrows. To eliminate wrinkles around the eyes, you should consider a face lift, and to raise the eyebrows, a brow lift. To correct a sagging lower lid that is gaping and causing a dry eye, you might need to undergo canthopexy.

Are You a Candidate for Blepharoplasty?
According to the American Society of Plastic Surgeons, eyelid surgery was the fourth most common surgical cosmetic procedure performed in 2006. About 233,000 blepharoplasty procedures were performed in 2006.

If you are considering blepharoplasty, you should be in good overall health, have no pre-existing diseases or medical conditions, be mentally and emotionally stable and have realistic expectations. Most people may start to think about having blepharoplasty when they are in their late thirties to mid-forties. However, if you have droopy or fatty eyelids, you may consider eyelid surgery at an earlier age.

You may not be a good candidate for eyelid surgery if you have certain eye problems, such as dry eye, glaucoma or a detached retina. If you have puffy or swollen looking eyes due to hyperthyroidism, you may not be a good candidate for blepharoplasty. Eyelid surgery is not effective for reducing edema (swelling from fluid retention) around the eyes.

A blepharoplasty can be used to correct blepharoptosis, or droopy eyelid, which is caused by a malfunction of the levator muscles that raise the eyelid. Blepharoptosis is sometimes just called ptosis, a word that can also be applied to any body part that is drooping out of its normal position. Ptosis can also describe when loose skin on the eyelid is sagging down over the upper lid and partially obstructing the eye.

The following factors should be taken into consideration if you are thinking about blepharoplasty:

Physical Health: You should be in good overall health and free of any active diseases or other medical conditions. Conditions such as diabetes, high blood pressure, or heart disease make it difficult for patients to endure the surgery and recover well. Make sure your surgeon knows if you have any allergies and what medications (including all vitamin or mineral supplements and herbal products) you take regularly.

Mental Health: Healing after any surgery can be difficult and tedious. You will need patience and mental strength. Some people become depressed after cosmetic surgery and it is important to ensure that this temporary depression does not worsen a pre-existing depression.

Realistic Expectations: You should discuss your desired results with your surgeon. You need to know if your goals are realistic and can be attained through surgery. Having your eyelids done can make you look younger and more refreshed. It cannot restore your youth. You and your surgeon can examine before-and-after photos to be sure you both are in agreement about the end result and your desired appearance.

In most cases, medical insurance will not cover the costs of blepharoplasty. The cost of the procedure may be covered if your vision is impaired, but you will have to find this out from your insurer. If your eyelid lift is not covered by your insurance, financing can be arranged.

How a Blepharoplasty Is Performed
A blepharoplasty usually takes 1 to 3 hours to perform. If both upper and lower eyelid procedures are being done, or if other procedures such as a face lift are done, the surgery will last longer.

When both upper and lower eyelids are being operated on, the blepharoplasty is usually performed first. This is because larger amounts of skin are removed with blepharoplasty. The exception is when unusually large bags are present beneath the eyes.

During the blepharoplasty surgery, your surgeon will remove any excess skin or herniated fat. Normally, there are some pads of fat around the eye and lid. Herniated fat is when any of this fat is pushed out of place or has sagged out of place due to aging.

Blepharoplasty can be done in a surgeon’s office, a freestanding surgery clinic or in a hospital. Usually, you go home after your surgery, but someone will need to drive you home.

In most blepharoplasty procedures, the incisions are made in the crease of the upper eyelid, where they will be hidden in the natural fold. The incision for lower eyelid blepharoplasty can be made just below the eyelashes on the lower lids, where they are not noticeable when they heal. However, in most lower lid blepharoplasty, the incisions are made on the inside of the eyelid (transconjunctival or through the conjunctiva) and fatty tissue is removed. During the surgery, your eye will be protected by a plastic shield similar to a contact lens.

In either procedure, the surgeon will loosen skin from the underlying tissue and remove fat and adjust or rearrange the muscles. Then he or she will remove excess skin, if needed, redrape the skin into a smoother position, and close the incisions using tiny sutures.

There are several phases involved in blepharoplasty surgery:

Preparation: During this phase, you are being “prepped” for surgery. Your surgeon will mark you to indicate where incisions will be made. The placement of these incision lines will be dictated by the technique being used. You will be attached to monitors that will keep track of your vital signs and an intravenous (IV) line will be started.

Anesthesia: The choice of anesthesia used during the blepharoplasty procedure should be discussed between you and your surgeon before the day of your surgery. Eyelid surgery is frequently performed with only local anesthesia, which numbs the area around the eye, and medications to keep you relaxed. After administering the anesthetizing agent, the surgeon will make sure you are fully anesthetized before beginning the procedure.

Surgical Procedure: The surgical procedure phase begins after anesthesia is administered. At the start of surgery, the surgeon will place a protective plastic shield over your eyeball. Once the incisions are closed and the shield is removed, the surgical team will apply a dressing to protect the incisions and to keep the tissue securely in place and reduce swelling. At the conclusion of the surgery, the surgeon will put lubricating ointment or drops in your eyes.

Recovery: After surgery, you will wake up and be moved to a recovery room where you will be monitored for about 2 hours. You may feel pain, discomfort, nausea or cold. The staff can give you pain relievers, antinausea medications and warm blankets. You may also feel emotionally upset, but this will pass.